Provider Demographics
NPI:1538898879
Name:HENRIKSEN LLC
Entity type:Organization
Organization Name:HENRIKSEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-956-6337
Mailing Address - Street 1:3623 NE JOHN OLSEN AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5815
Mailing Address - Country:US
Mailing Address - Phone:503-855-4415
Mailing Address - Fax:
Practice Address - Street 1:3623 NE JOHN OLSEN AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5815
Practice Address - Country:US
Practice Address - Phone:503-855-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15-2458Medicaid